About one in 20 middle and high school students who chew tobacco and use other smokeless tobacco products also smoke cigarettes, a new Harvard School of Public Health (HSPH) study shows. The findings suggest smokeless tobacco products may increase – rather than reduce – health risks from cigarettes and other traditional smokes. While cigarette use has declined over the past 10 years, smokeless tobacco use has remained at 5%, the researchers reported.

The group analyzed questionnaire responses from 18,866 U.S. students in sixth to 12th grade classrooms at 178 schools in the 2011 National Youth Tobacco Survey. The researchers found about three-fourths of the approximate 6% of teens in the study who used “chaw,” snuff, or other such products also smoked cigarettes. Teens with friends and family members who smoked were especially at risk of using both.

Constantine Vardavas, coauthor and senior research scientist at the Center, discussed the findings August 5, 2013 with the website MedPage Today.

“Clinicians when they are engaging an adolescent patient shouldn’t only ask ‘Do you smoke cigarettes?,’ but also ‘Do you use any form of tobacco, including smokeless?’,” Vardavas told MedPage Today. “It’s important that a clinician convey the message that all tobacco products are harmful.”